Abstract 1956: Perioperative opioid analgesia affects the circulating tumor cells levels in colorectal cancer patients
Authors: Pavel Stejskal, Josef Srovnal, Emil Berta, Alona Rehulkova, Lubomir Vecera, Filip Haiduk, Pavel Michalek, Marian Hajduch
Journal: Cancer Research (2022)

Abstract Purpose Colorectal cancer (CRC) is one of the most common cancers worldwide and metastases-related death is the main cause of its high mortality. Previous studies showed the poorer survival in colorectal cancer patients treated perioperatively with morphine in comparison to piritramide. Circulating tumor cells (CTCs) are considered as precursors of distant metastatic spread and can act as an independent prognostic and predictive biomarker. The hypothesis that different pain-killers used in perioperative period can affect the CTCs levels was tested. Patients and methods In total, 100 CRC stage I-III patients undergoing radical surgery were enrolled in this prospective multicentric randomized pilot study (NCT03700411). Three peripheral blood samples were collected into Cell-Free DNA BCT® (Streck, Inc.) preoperatively, one day and one month after surgery respectively. Patients were randomized into three arms using different perioperative analgesia - morphine, piritramide and epidural analgesia. The CTCs were identified using the CytoTrack CT11࣪ (2/C, Denmark), a semi-automated immunofluorescence microscopy detecting the pan-cytokeratin and EpCAM signals. The method recovery rate was analyzed using SW-480 cancer cell line by flow cytometry. Results The CTCs were found most frequent in the samples obtained at first day after surgery (44,9%) followed by the samples collected before surgery (36%). The lowest levels were observed in control samples one month after surgery (31%). The significant increase of CTCs levels was found in majority of patients treated with morphine (16,3%) compared to piritramide and epidural analgesia. However, the significant decrease of CTCs levels was observed in samples drawn one month after surgery in both, morphine and piritramide arm. There were no significant changes in CTCs levels of patients with epidural analgesia. The CTCs recovery rate of the method was 72%. Conclusion The significant increase of CTCs levels was found in postoperative blood samples of CRC patients treated with morphine compared to the piritamide and epidural analgesia. The enrollment into the study is ongoing. Acknowledgements This study was supported by Ministry of Health of the Czech Republic (NV18-03-00470), Ministry of Education, Youth and Sport of the Czech Republic (LM2018132), Palacky University Olomouc (LF 2021_019) and European Regional Development Fund (ENOCH CZ.02.1.01/0.0/0.0/16_019/0000868, ACGT CZ.02.1.01/0.0/0.0/16_026/0008448). Citation Format: Pavel Stejskal, Josef Srovnal, Emil Berta, Alona Rehulkova, Lubomir Vecera, Filip Haiduk, Pavel Michalek, Marian Hajduch. Perioperative opioid analgesia affects the circulating tumor cells levels in colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1956.